How One Pain Pill Sparked A Three-Fold Increase In Heroin Deaths

A prescription painkiller originally pitched as difficult to abuse bears primary responsibility for propelling the recent heroin epidemic ravaging the U.S., according to researchers.

Purdue Pharma created the powerful prescription painkiller OxyContin in 1996, but the pain pill proved easy to abuse and highly addictive. The 12-hour extended release pill could be chewed, crushed to snort and even injected to deliver an immediate, concentrated dose of pain relief. Widespread abuse of the drug eventually gave way to lawsuits and in 2007 Purdue Pharma plead guilty to misleading the public on the additive nature of the pill, paying $600 million in fines, reports The Washington Post.

Following the lawsuits Purdue Pharma reformulated the drug in 2010 to reduce the possibility for abuse. In the absence of abusable Oxycontin, former users turned to heroin in large numbers to attain the same high. Researchers from RAND Corp. and the Wharton School concluded abuse-deterrent OxyContin is directly responsible for roughly “80% of the three-fold increase in heroin mortality since 2010.”

“States with the highest initial rates of OxyContin misuse experienced the largest increases in heroin deaths,” wrote the authors in the National Bureau of Economic Research. “Results show that this differential increase in heroin deaths began precisely in the year following reformulation.”

OxyContin addiction did not have any measurable relationship with heroin deaths before the reformulation in 2010. Many people who overdose on heroin begin with a dependence on prescription painkillers like OxyContin, but switch after building high tolerances that make them too expensive.

In the case of OxyContin, which is one of the most powerful painkillers available, users turned to heroin after the reformulation by Purdue Pharma. Experts say the addiction to opioids becomes so strong it can alter brain chemistry and suppress even the strongest instincts, like caring for children.

“That doesn’t mean supply reduction is bad, you just need broader supply reduction policies,” David Powell of the RAND Corp. and co-author of the study, told The Washington Post. “They were basically just taking out one component of this abuse chain.”

The reformulation succeeded in its intended purpose of reducing overall abuse of OxyContin, but it came with disastrous unintended consequences. There are 3.1 more heroin deaths per 100,000 people for every percentage decrease in OxyContin abuse.

The FDA is promoting the creation of more abuse-deterrent prescription pain medications to replace the current pills in production. The researchers fear this could further fuel the current heroin epidemic by reducing options for people suffering from opioid abuse without addressing the underlying addiction.

Heroin deaths contributed to the first drop in U.S. life expectancy since 1993 and eclipsed deaths from motor vehicle accidents in 2015. The substance accounts for roughly 63 percent of drug fatalities, which claimed 52,404 lives in the U.S. in 2015.

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